HEDIS Program Consultant III

About the role

The HEDIS Program Consultant III is part of the HEDIS Audit and Submissions team and is primarily responsible for providing project management support and subject matter expertise for HEDIS measure production.

Responsibilities

• Aid in planning and managing multiple projects related to HEDIS/QRS measures to ensure accurate and valid data.
• Lead and participate in planning efforts to identify opportunities that support Medica’s priorities and meet customer requirements.
• Build and maintain strong relationships with vendors, regulatory agencies, and internal and external stakeholders.
• Serve as a key point of contact for the HEDIS software vendor, HEDIS auditor, and for submission of quality measurement data to accreditation, federal, and state regulatory bodies.
• Support the annual submission of HEDIS and QRS reporting, including the compliance audit.
• Cook with and chase chart logic for the Clinical Quality Review team and external vendors.
• Stay current on regulatory requirements and contribute to ongoing improvements in HEDIS and QRS data collection processes.
• Document and maintain team processes and project plans to track progress and ensure timelines are met.
• Support reporting processes that incorporate results from certified HEDIS® software vendors, NCQA, CMS, state agencies, and other relevant sources.
• Collaborate across the organization with teams including Quality, Analytics, Network Management, Claims Operations, Information Technology, and Market Business Segments to monitor key quality metrics and support organizational priorities.

Requirements

• Bachelor's degree or equivalent experience in related field
• 5+ years of related work experience in Project Management

Preferred Qualifications

• Project management experience with HEDIS audit and submissions with demonstrated success facilitating/leading complex projects with drive and initiative.
• Knowledge of health care regulatory entities and related reporting requirements.
• Experience working with multidisciplinary teams, navigating a large organization, and professionally interacting with external vendors and provider organizations.
• Demonstrated experience documenting processes, utilizing web-based applications, and making recommendations on new procedures/projects to influence the team and goals.
• Ability to manage multiple projects and priorities; comply with tight deadlines.
• Ability to manage relationships and work collaboratively to achieve solutions and goals.
• Ability to adapt to ever-changing quality measurement application tools.
• Strong knowledge of the health care industry including but not limited to HEDIS production, health care products, payment systems, operations, policies and procedures.
• Ability to explain health care quality measures and related processes in layman’s terms.
• Strong written and verbal communication skills and listening skills.
• Creative problem solving and critical thinking abilities.

Benefits

Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

Pay

The full salary grade for this position is $78,700 - $134,900. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $78,700 - $118,020. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data.

Schedule

This position is an Office role, which requires an employee to work onsite at our Minnetonka, MN office or Madison, WI office, on average, 3 days per week.